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Application For Water or Waste Water Services
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APPLICATION FOR WATER OR WASTE WATER SERVICE
**MUST RETURN IN PERSON WITH PHOTO ID**
If your parcel number is unknown,
look it up online
prior to filling out this form.
IF OCCUPANT OTHER THAN OWNER, LETTER FROM OWNER AUTHORIZING INSTALLATION/BILLING TO BE SENT TO OCCUPANT MUST BE ATTACHED. CURRENTLY ONLY CHECK, CASH, CASHIER CHECK OR MONEY ORDER ARE ACCEPTED FOR PAYMENT.
Signature of Owner / Occupant
*Must be signed by hand.
NOTICE: COST OF INSTALLATION IS NOT COVERED BY PERMIT FEE.
Installation cost will be billed when charges have been finalized.
The following information is required by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program.
You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in anyway.
However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
Hispanic or Latino
Not Hispanic or Latino
American Indian / Alaskan Native
Black or African American
Native Hawaiian or Pacific Islander
This institution is an equal opportunity provider.
Esta institucion es de oportunidad igualada.
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